Development and Implementation of a Pilot Transition Preparation Intervention for Young Adults With Type 1 Diabetes in an Integrated Healthcare Setting

• Published in: Journal of pediatric psychology Vol. 48; no. 3; pp. 228 - 240
• Main Authors: Caccavale, Laura Jean, LaRose, Jessica Gokee, Mazzeo, Suzanne E, Bean, Melanie K
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 20-03-2023
• Subjects: Adolescent; Adult; Clinical Trials; COVID-19; Delivery of Health Care, Integrated; Diabetes Mellitus, Type 1 - psychology; Diabetes Mellitus, Type 1 - therapy; Feasibility Studies; Female; Glycated Hemoglobin; Humans; Male; Young Adult; pilot/feasibility trial; diabetes; self-management; young/emerging adults
• ISSN: 0146-8693; 1465-735X; 1465-735X
• DOI: 10.1093/jpepsy/jsac084

Abstract
Objective
To evaluate the feasibility, acceptability, and preliminary efficacy of a multisystem transition preparation intervention, SHIFT, for young adults (YAs) with type 1 diabetes (T1D).
Methods
A single-arm, clinic-based pilot was conducted with 25 YAs with T1D (M age = 18.9 ± 1.0 years; 80% female), their parents (n = 25), and their providers (n = 10). Young adults and parents participated in a 6-month intervention designed to enhance transition readiness and independent diabetes management. Providers viewed a video module highlighting their role preparing YAs for transition and received individualized reports of YA’s goals and transition readiness. Intervention feasibility (i.e., recruitment, retention, and engagement) and acceptability (e.g., program satisfaction) were assessed. Assessments of transition readiness, diabetes engagement, hemoglobin A1c (HbA1c), and related psychosocial variables were conducted at baseline, post-intervention (6 m), and follow-up (9 m). Paired t-tests examined 0–6 m and 0–9 m changes in study constructs.
Results
SHIFT was feasible, evidenced by recruitment (100% of sample recruited in 4 m), retention (100% at 6 m), and YA session attendance (100%). Program satisfaction was high for YAs, parents, and providers (9.12 ± 1.40, 8.79 ± 1.56, 8.20 ± 1.30, respectively, [out of 10]). Significant improvements (with effect sizes ranging from small to medium) were observed in parent and YA-reported transition readiness at 6 and 9 m (ps<.05) and diabetes engagement at 9 m (ps<.05). Although based on limited data due to COVID-19-related disruptions, a potential reduction in HbA1c was also observed.
Conclusion
Findings support the feasibility, acceptability, and preliminary efficacy of SHIFT (although limited by the single arm design and homogeneous sample), and suggest a larger randomized controlled trial is warranted.